Abstract
Sirs: We would like to remind readers of a rare cause of changes in semen quality subsequent to the following case which recently presented to our department. A 25-year-old man visited our department with a three-week history of orange-coloured watery semen. This was not associated with any discharge, dysuria, testicular or perineal pain. He had been working in Africa prior to his visit and during that time had swum in Lake Malawi. He had developed a flu-like illness six weeks after swimming in the lake and the changes in his semen were noted subsequent to that. He did not have any respiratory symptoms. He did not have any medical problems, was otherwise fit and well and was not on any medication. Examination was completely unremarkable. A routine sexually transmitted infection (STI) screen, comprising a urine chlamydia nucleic acid amplification test, urethral culture for gonorrhoea, HIV and syphilis serology was negative. Urinalysis and semen microscopy and culture were unremarkable but a serum schistosomal enzyme-linked immunosorbent assay (ELISA) performed on blood taken at presentation was positive.
The patient was subsequently treated with two doses of praziquantel 20 mg/kg and his symptoms resolved.
Schistosomiasis is caused by flukes and is an increasingly common diagnosis in non-endemic counties due to increased travel to endemic countries, particularly Africa, South East Asia, the Middle East and Brazil. 1 Initially, patients may present with an itchy, papular rash (swimmer's itch) and may develop ‘Katayama fever’ (fever, cough, wheeze and diarrhoea) approximately eight weeks after exposure. Clinical schistosomiasis is due to the immunological response of the host and may affect multiple systems. Travel history is extremely important in raising the index of suspicion and travellers may present acutely with other symptoms, e.g. transverse myelitis. Genitourinary schistosomiasis may present with dysuria, frequency, haematuria and haemospermia; however, subjective changes in semen quality and colour have also been reported. 1,2 Left untreated it may result in renal failure and is associated with an increased risk of squamous cell carcinoma of the bladder.
Diagnosis is made by serology (schistosoma ELISA), mid-day urine collection for eggs or stool examination for ova. Serological testing may be negative for up to eight weeks postexposure. Treatment is with praziquantel 40 mg/kg in divided doses.
We hope that this case will remind readers of the importance for prompt diagnosis and treatment of this serious condition and its potential presentation to sexual health clinics.
Footnotes
ACKNOWLEDGEMENTS
There are no conflicting interests or funding sources. CK collated the data and wrote the first draft. All authors read and commented on the contents. CK incorporated their recommendations and produced the final draft. All authors were involved in management and patient care.